Blastocystis is usually considered to be nonpathogenic, with its main significance indicating an fecal-oral exposure. However, transplant patients may develop a diarrhea that implicates Blastocystis as the cause.
Patient selection: status post (renal, bone marrow, stem cell, other)
Clinical presentation: diarrhea, which may be watery or dysentery-like.
Features of a significant Blastocystis infection:
(1) very large numbers of Blastocystis in the stool (> 5 per high power microscopic field)
(2) focal neutrophil infiltration of the rectal mucosa
(3) clinical response to prolonged metronidazole therapy
(4) exclusion of other causes of diarrhea
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